Trends in urethral stricture management over two decades

Abstract

Objectives To identify trends in the management of urethral stricture disease in Australia, assess changes in the standard of care, and examine the availability of genitourinary reconstructive surgery. Methods Data on eight stricture management procedures were collected online via Medicare Item Reports from the Australian Government Department of Human Services, and then matched to population data from the Australian Bureau of Statistics. A survey was disseminated via the Urological Society of Australia and New Zealand (USANZ) asking whether active members performed urethroplasty and whether this was done in a rural, regional or metropolitan setting. Results Over a 22‐year period, there were 140 540 endoscopic procedures and 5136 urethroplasties, with 27.4 endoscopic procedures per urethroplasty. From 1994 to 2016, the per capita number of passage of sounds and dilatation procedures decreased by 74% and 75%, respectively, with increases in use of optical urethrotomy of 70% and in single‐stage urethroplasty of 144%. Overall, the ratio of all endoscopic procedures vs urethroplasty decreased from 58.9 to 16.8. There were as few as 16 surgeons in the USANZ performing urethroplasty, with seven providing this service in regional areas. Seven had formal fellowship training. Conclusion There has been a clear shift from repetitive endoscopic procedures towards urethroplasty, but the former still make up the majority of interventions. This may be explained by patients not being referred for urethroplasty earlier in the course of disease and there appears to be a gap in genitourinary reconstructive expertise in regional and rural areas.

Management of benign prostatic hyperplasia in the 21st century: temporal trends in Australian population‐based data

“…In particular, Aquablation (AquaBeam â ; Procept BioRobotics, Redwood Shores, CA, USA) is a novel technique that does not have a specific MBS billing code, and therefore is not yet able to be captured by these data. As forecasted by previous authors, an increasing prevalence of BPH surgery is expected to contribute to greater incidence of urethral stricture disease; however, the present dataset does not allow us to asses this relationship [43,44]. Furthermore, the use of medical agents not subsidised by the PBS (purchased via 'private' prescription), such as prazosin, tamsulosin, silodosin and herbal supplements, was unable to be quantified.…”

Narrowing in on urethral strictures

“…2 Quality of life is reduced by urethral strictures, with many patients experiencing recurrent urinary tract infections, bothersome LUTS and progression to acute urinary retention. 3,4 The general practitioner (GP) is often the first point of contact for men affected by LUTS. While there are numerous causes of LUTS for the GP to consider (Table 1), early recognition and prompt referral to a urologist are crucial for reducing the morbidity from a urethral stricture.…”

“…19,20 Such recurrences can lead to a chronic stricture state requiring repeated urethrotomies, which makes subsequent urethroplasty more difficult. 4,21 Many urologists still offer urethrotomy as a first-line treatment; however, its success depends on stricture location, stricture length, number of strictures, amount of surrounding spongiofibrosis and number of previous urethrotomies. 20,21 This is reflected in the current urethral stricture guideline published by the AUA, which states that surgeons may offer urethral dilation or endoscopic urethrotomy for the initial treatment of a short (<2 cm) bulbar urethral stricture.…”

“…Nonetheless, over the past two decades, there has been a sizable reduction in endoscopic procedures and corresponding increase in urethroplasty in Australia. 4 Specifically, from 1994 to 2016, the number of urethral dilation procedures performed across Australia decreased by 75%, and the number of urethrotomy or urethrostomy procedures decreased by 84%. 4 During this period, the number of single-stage urethroplasty procedures increased by 144%.…”

“…4 Specifically, from 1994 to 2016, the number of urethral dilation procedures performed across Australia decreased by 75%, and the number of urethrotomy or urethrostomy procedures decreased by 84%. 4 During this period, the number of single-stage urethroplasty procedures increased by 144%. 4…”